The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Welcome back to the Friday Breeze! Brace yourself, because with the midterms in the rear-view mirror (psshh, the 2018 elections are so five minutes ago), lawmakers, hopefuls and sideline experts are all barreling toward 2020. (I have only just this moment realized the vast opportunity for puns we’ll see when it’s over. Hindsight being … you get it.) First, though, everyone has to make it through two years of likely gridlock with a split Congress.

So what’s on the agenda for the newly empowered Democrats?

“Health care was on the ballot and health care won.” That’s House Minority Leader Nancy Pelosi’s assessment, at least. How it shakes out is trickier.

Some of the Dems’ top priorities are related to bandaging up the health law. Their efforts will likely include forcing a vote on a bill to protect preexisting conditions; shoring up the marketplaces, possibly by helping states pay for large medical claims; and pushing to get the House to intervene in the Texas lawsuit that challenges the law’s constitutionality.

At the same time, many of the party’s 2020 contenders are going to be on the trail going hard for “Medicare-for-all,” aka the litmus test for candidates who want to woo the more progressive wing of voters. The dissonance in the party that has been brewing since MFA gained popularity is at the very least going to require some complicated political maneuvering on all sides.

One Democratic agenda item many people (including President Donald Trump) seem to agree on, though? Reining in drug prices.

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New numbers out of Arkansas that detail just how many people have been dropped from the state’s Medicaid program since work requirements were enacted have experts increasingly alarmed. An additional 3,815 lost coverage in October for not reporting their hours, pushing the total number of people who have been affected by the state’s new requirements to over 12,000. And about 6,000 more residents are on their second strike and poised to lose coverage next month.

An outcry among health care experts prescribes the rules be suspended until officials figure out why the numbers are so startlingly high.

The Food and Drug Administration is cracking down on certain tobacco products and e-cigarettes that contribute to the emerging teen-vaping epidemic. But the ban on selling flavored e-cigarettes at brick-and-mortar stores (a ban that won praise when an early version of the rules was leaked) was conspicuously tempered. Stores will be allowed to sell the products if they can be kept in an age-restricted area.

The agency did come out swinging hard with a proposed ban on menthol. It could take years to enact, and the tobacco industry has hinted at a court battle, but if the ban does go through, it could have a profound effect on African-American males and young people who smoke menthol cigarettes at higher rates than other groups.

The National Rifle Association has long been a Goliath among Davids when it comes to election spending. New numbers suggest, though, that the gun control movement may actually become a formidable foe for the political powerhouse.

It was not a friendly news week for the NRA in general. One of the organization’s tweet’s (a suggestion that doctors should “stay in their lane” on the gun debate) sparked viral outrage from providers. With the floodgates opened, stories of physicians’ firsthand experience with gun violence blanketed social media. “I see no one from the @nra next to me in the trauma bay as I have cared for victims of gun violence for the past 25 years,” tweeted one doctor (from the New York Times’ coverage). “THAT must be MY lane. COME INTO MY LANE. Tell one mother her child is dead with me, then we can talk.”

The wildfires continued to devastate California, with the death toll climbing to at least 63 and the number of missing people soaring to more than 600. Heartbreaking tales about elderly and young evacuees living in the harsh conditions of parking-lot tent cities serve as a reminder of just how long recovery will take after the fires are contained.

Drug prices didn’t always used to be this bad. For a while, America was spending about what other wealthy countries did. Then something happened in the 1990s. To be fair, many factors are in play with our current pricing system, but the record number of new drugs that emerged in that decade likely set the stage for our current morass.

Enrollment in Affordable Care Act plans was a bit slower at the start of this year’s sign-up season compared with last year’s. The reason this item appears so low in this newsletter, though, is that those numbers lack context (we, as a nation, were kind of preoccupied with a little thing called the midterms) and experts say it’s too early to call this a trend. Something to keep an eye on.

Sick of medical bills? Yeah, doctors aren’t really fans of having to be debt collectors either. Especially when it comes to a patient. As premium costs shift more and more to employees, providers are no longer able to just deal with impersonal insurers and are instead having to go after the very people they’re trying to help.

Who in the family doesn’t get health care this year? Americans are having to make such tough decisions in an era where insurance plans can be price-tagged at more than $1,000 a month. Bloomberg offers a series that puts names and faces to the problem that has been a punch in the gut for many across the country.

Who decides the parole of people who have been found not guilty by reason of insanity? In Oregon, where it’s a board that reviews the state’s cases, the balance between civil rights and safety has been praised. However, an analysis of 220 defendants found that about a quarter of them were charged with attacking others within three years of being released. And the board hasn’t changed its policies.

In an era of medical malpractice suits, it feels rare to get an apology out of anyone health-related these days. But the widower of a woman who died of an asthma attack outside of a locked emergency department got one from the hospital. (It’s a tragic, yet recommended read overall.)

Election Day was Nov. 6, but results remain undetermined in some races at the state and federal levels. Nonetheless, it is already clear that the election could have major implications for health policy in 2019.

The current Congress is back in Washington for a lame-duck session, and while the budget for the Department of Health and Human Services is set for the fiscal year that began Oct. 1, other health bills, including ones addressing AIDS and bioterrorism, are on the to-do list.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Kimberly Leonard of the Washington Examiner and Alice Ollstein of Politico.

Among the takeaways from this week’s podcast:

With the political divide between a Republican Senate and a Democratic House, getting legislation passed in the next Congress may prove hard. But bipartisan support could arise for bills to protect consumers from surprise medical bills and, perhaps, to control some drug prices.

The House will likely spend much of its time exercising oversight responsibilities, including possible probes of the Trump administration’s policies on separating immigrant children from their parents, changes in health law rules for contraception coverage, changes in Medicaid and the administration’s decision not to defend the Affordable Care Act in a key court case.

Among the issues on state ballots this month was a constitutional amendment in Alabama that makes it state policy to “recognize and support the sanctity of unborn life and the rights of unborn children.” Although abortion opponents hail such “personhood” measures, they have been defeated in other states because they could impinge on infertility treatments, such as in vitro fertilization. It’s not clear whether the Alabama measure will be challenged in court because of that.

On the ballot in Oregon and Washington were industry-backed measures that would stop localities from instituting soda taxes. The effort failed in Oregon and passed in Washington.

During Congress’ current lame-duck session, members will be looking to pass an appropriations bill for parts of the government. Although HHS already got its appropriations bill, other health measures — such as the renewal of the PEPFAR global HIV initiative, grants for states on bioterrorism and pandemic planning, and changes to Medicare’s doughnut hole funding — could be added.

A tweet by the National Rifle Association urging doctors to keep out of the gun control debate and “stay in their lane” has provoked a furor from doctors, who say they must deal with the ramifications of a flawed policy.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too:

Voters on Election Day gave control of the U.S. House to the Democrats but kept the U.S. Senate Republican. That will mean Republicans will no longer be able to pursue partisan changes to the Affordable Care Act or Medicare. But it also may mean that not much else will get done that does not have broad bipartisan support.

Then the day after the election, the Trump administration issued rules aimed at pleasing its anti-abortion backers. One would make it easier for employers to exclude birth control as a benefit in their insurance plans. The other would require health plans on the ACA exchanges that offer abortion as a covered service to bill consumers separately for that coverage.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

The Trump administration’s new contraception coverage rule comes after an earlier, stricter regulation was blocked by federal courts.

The insurance bills that the Trump administration is now requiring marketplace plans to send to customers for abortion coverage will be for such a small amount of money that they could become a nuisance and may persuade insurers to give up on the benefit.

House Democrats, when they take control in January, say they want to move legislation that will allow Medicare to negotiate drug prices. But fiscal experts say that may not have a big impact on costs unless federal officials are willing to limit the number of drugs that Medicare covers.

It appears that both Democrats and Republicans in Congress are interested in doing something to protect consumers from surprise medical bills. The issue, however, may fall to the back of the line given all the more pressing issues that Congress will face.

One of the big winners Tuesday was Medicaid. Three states approved expanding their programs, and in several other states new governors are interested in advancing legislation that would expand Medicaid.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too:

]]>New_WTH_logo_Orange_1350khnlydiaCalifornia’s Top Lawyer Sees Election Win As Mandate To Sustain Trump Resistancehttps://khn.org/news/californias-top-lawyer-sees-election-win-as-mandate-to-sustain-trump-resistance/
Thu, 08 Nov 2018 17:20:42 +0000http://kaiserhealthnews.wordpress.com?p=889779&preview=true&preview_id=889779California Attorney General Xavier Becerra has cemented his role as one of the nation’s top defenders of the Affordable Care Act, filing multiple lawsuits in the past two years to uphold key protections of the law and often clashing with the Trump administration.

Voters this week gave Becerra a clear mandate to continue that work, he said.

“Californians had a chance to register their opinion on the work that I’ve done,” Becerra told California Healthline on Wednesday, the day after voters overwhelmingly elected him to the state’s top law enforcement job — 61 percent to 39 percent over Republican Steven Bailey.

“My sense is there’s a pretty clear signal.”

Becerra has filed 44 legal challenges against the Trump administration in less than two years on cases involving immigration, birth control, health care, transgender rights, net neutrality, climate change and other issues.

Four of the lawsuits involve former President Barack Obama’s signature achievement, the 2010 federal health care law, which Trump and fellow Republicans have sought to dismantle. In one key case, Becerra is leading more than a dozen other Democratic attorneys general against a Texas-led GOP lawsuit challenging the law’s constitutionality.

“We’re defending health care protections and rights not just for the 40 million Californians, but for the 320 million Americans in the country, because the Trump administration elected to back out of their role in defending a federal statute,” Becerra said. “We stepped in and are now the lead state defending the Affordable Care Act. That’s a big undertaking.”

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Democratic Gov. Jerry Brown appointed Becerra to the top post at the state Department of Justice in December 2016 after Kamala Harris was elected to the U.S. Senate. So, Tuesday’s election was the first time that the 60-year-old Democrat, who previously served in Congress, won a statewide office.

Bailey had criticized Becerra for fighting Washington instead of focusing on California issues — not an argument that resonated with voters in a state that prides itself as the head of Trump resistance.

Becerra said he has sought to spotlight health care at the state Justice Department, creating a new “strike force” of attorneys who have expertise in health care issues.

Becerra, the son of Mexican immigrants, said he also is ready to defend California should state lawmakers decide to extend health care coverage to unauthorized immigrant adults (children already are eligible). That could spur a legal challenge and would not likely be supported by the Trump administration.

The state’s estimated 1.8 million unauthorized immigrants make up nearly 60 percent of the state’s remaining uninsured residents. Covering them is key to Democratic leaders’ goal of insuring all Californians.

Aside from tangling with Trump, Becerra also has taken on both the hospital and pharmaceutical industries.

This year, he filed a lawsuit against Sutter Health, the largest hospital system in Northern California, for anti-competitive practices, and he is investigating pharmaceutical manufacturers and the three largest opioid distributors over unlawful practices. In 2017, Becerra joined a federal lawsuit that charges six makers of generic drugs with an illegal conspiracy to increase prices for an antibiotic and a diabetes medication. All three cases are pending.

In the Sutter Health lawsuit, Becerra said evidence will show that the hospital chain overcharged for services. While he has made anti-competitiveness a priority, he would not say whether he planned similar lawsuits against other hospitals. But he didn’t rule it out.

“We’re going to be vigilant to make sure that everyone follows the law and does what they’re supposed to,” Becerra said. “If we find that there are people who are acting anti-competitively or overpricing or trying to take advantage of California health care consumers, we’ll be prepared to act.”

All of the investigations and litigation, he said, are slow-moving. He compared the process to a football game in which most of the plays yield small gains, with an endgame in sight.

]]>California Governor Jerry Brown Addresses Dept. Of Justice Lawsuit Against CaliforniakhnshareMidterm Election Boosts Medicaid Expansion, But Challenges Remainhttps://khn.org/news/midterm-election-boosts-medicaid-expansion-but-challenges-remain/
Thu, 08 Nov 2018 10:00:13 +0000http://khn.org/?p=889332Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election.

Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures.

Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020.

Medicaid proponents also were celebrating the Democrats’ takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people.

“Tuesday was huge for the Medicaid program,” said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. “The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect.”

But health experts caution that GOP opposition won’t fade away.

David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. “I see this as a turning point in ACA politics,” he said. Still, he added‚ “it’s not inevitable.”

Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities.

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The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest.

GOP opposition has left about 4.2 million low-income Americans without coverage in various states.

“It’s not over until it’s over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. “But the trend overall has been to increasing implementation and increasing coverage.”

Montana Fails To Endorse Funding

Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program.

In addition, Democrats secured the governor’s offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it.

Current and incoming Republican governors in Utah and Idaho said they wouldn’t block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase.

It wasn’t a clean sweep, however, for Medicaid on Tuesday.

In preliminary results, a ballot issue to fund Montana’s Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products.

The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so.

Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected.

Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements.

“There are some people in the state who may not have disabilities but need some help to access coverage,” she said. “I think we can pass something without people having a gap in coverage. … That will be a priority.”

“It was never our intent to simply sunset the expansion and have it go away,” she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes.

Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along.

But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the state’s sales tax, just over a penny for a $10 purchase.

Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the state’s ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage.

“I think it showed there was a clear need for it,” he said. The legislature likely won’t block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps.

Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom lines because it cuts down on uninsured patients and uncompensated care.

“The broad population does see the value of Medicaid,” she said. “They saw it as a loss by their states not to accept the federal funds,” she said.

Despite the victories, Burke said, advocates should not assume other states such as Florida, Texas and Tennessee will follow suit.

“I don’t see a radical shift, but it moves us closer,” she said.

‘Fertile Ground’ For More Referendums

If advocates press for more referendums, Florida might be a tempting target. More than 700,000 adults there could become eligible, but the campaign would likely also be very costly.

Jonathan Schleifer, executive director of The Fairness Project, which financed the ballot initiatives in Maine in 2017 and the four states this year, refused to say which states would be targeted next.

The group is funded by the Service Employees International Union-United Healthcare Workers West, a California health care workers union.

“The GOP has been bashing the ACA for nearly a decade, and voters in the reddest states in the country just rejected that message,” Schleifer said. “It’s a repudiation and a tectonic shift in health care in this country.”

“There is fertile ground” for more such ballot votes, said Topher Spiro, vice president for health policy at Center for American Progress, a liberal think tank. “It is clear that public opinion is on the side of Medicaid expansion and the election results merely confirm that.”

“This will build momentum for expansion in other states,” he added.

The election results also could have consequences on efforts by states to implement work requirements for Medicaid enrollees.

New Hampshire and Michigan — which expanded the program but recently won federal approval to add controversial work requirements — could revisit that additional mandate as a result of Democrats winning control over both houses of the legislature in New Hampshire and the governor’s office in Michigan.

]]>Medicaid-Expansion-110718khnphilipgHouse Dems In New Seats Of Power Will Steer Health Policy, Attack Drug Priceshttps://khn.org/news/house-dems-in-new-seats-of-power-will-steer-health-policy-attack-drug-prices/
Wed, 07 Nov 2018 19:43:49 +0000http://khn.org/?p=889273For the first time since passing the Affordable Care Act, Democrats will soon control the House of Representatives and its powerful health committees. But Republicans’ tightened grip on the Senate means those hoping for another round of dramatic, progressive reforms may be disappointed.

Empowered by voters outraged over Republican attempts to chip away at the law’s protections for the sick, Democrats owe much of their midterm takeback to health care issues. And Democratic leaders say they are ready to get back to work, this time training their sights on skyrocketing drug prices, among other policy conundrums, with a majority of House votes and a slate of new committee chairmanships in hand.

In a few weeks, House Democrats will meet to elect their leaders, including several committee chairs who will be responsible for the nation’s health care policy and spending in the coming years. Hill denizens expect those currently serving as the top Democrat on most House committees to ascend to the chairmanships, with few if any members mounting serious challenges.

Those basking in a post-“blue wave” glow would do well to temper their expectations, recalling that the Republican-controlled House had already voted 54 times to unravel some or all of the Affordable Care Act by its fourth birthday in 2014. In most cases, Democrats in the Senate and White House stopped those efforts in their tracks.

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With the Senate (and the presidency) remaining under Republican control and even fewer moderate Republicans left in the House after this election, Democrats will struggle to move legislation without Republican support. What they can do is hold hearings, launch investigations and generally unnerve the pharmaceutical industry, among other likely adversaries.

And there’s a chance they could strike a deal with President Donald Trump, whose administration is moving to crack down on drug companies.

Who are the members most likely to wield the gavels? And what will they do with that power? Here’s a look at some of the major committees that influence health policy — and the people who may lead them.

The Committee on Energy and Commerce: Rep. Frank Pallone, New Jersey

Pallone, who has served in the House for 30 years, became the top Democrat on this influential committee in 2015. Should he become chairman, he would be responsible for the broadest health portfolio in the House, which includes Medicaid, public health, insurance and drug safety. This is the committee that marked up the Affordable Care Act in 2009 (when Pallone chaired the health subcommittee) and the House Republican repeal effort in 2017.

Unsurprisingly, his influence over health care issues has attracted a lot of money from pharmaceutical companies, health professionals, HMOs and other industry players. By mid-October, Pallone had received more than $945,000 in campaign contributions from the health sector for this election, according to the Center for Responsive Politics. According to a KHN analysis, nearly $170,000 came from political action committees associated with pharmaceutical companies.

The Committee on Oversight and Government Reform: Rep. Elijah Cummings, Maryland

Cummings could prove the pharmaceutical industry’s biggest headache come next year. Having served as the committee’s ranking member since 2011 — a post that lacks the chairman’s subpoena power — he has been champing at the bit to hold drugmakers accountable.

Drugmakers have wasted few campaign contributions on Cummings: He has received just $1,000 from their PACs this election, according to data analysis by KHN.

In a statement to Kaiser Health News, Cummings said Democrats would conduct “credible, responsible oversight” of the Trump administration, adding: “For healthcare, that means investigating skyrocketing prescription drug prices, actions that would threaten protections for people with preexisting health conditions, and efforts to undermine the Medicaid program.”

The Committee on Ways and Means: Rep. Richard Neal, Massachusetts

Ways and Means oversees Medicare and influences health policy through its jurisdiction over taxes. Though Neal became the top Democrat on this committee in 2017, he has been involved in health care much longer, having played a part in the crafting of both the Affordable Care Act and the failed reform effort under the Clinton administration in 1993.

Facing a primary challenger who touted her support for “Medicare-for-all” in his deep-blue district, Neal denied that he opposes the progressive single-payer proposal. But he also said Democrats should focus on shoring up the Affordable Care Act, particularly its protections for those with preexisting conditions and caps on out-of-pocket expenses. (He won handily.)

The health sector was by far one of the top contributors to Neal’s re-election campaign this year, giving more than $765,000, according to the Center for Responsive Politics. Neal’s district includes the headquarters of several health insurers and other medical companies, which makes him a prime target for campaign contributions.

The Committee on Appropriations: Rep. Nita Lowey, New York

If chosen, Lowey would become the first woman to chair the powerful House Committee on Appropriations, holding the nation’s purse strings.

Like Neal and Pallone, Lowey was first elected to Congress in 1988, and she became the committee’s top Democrat in 2013. She has been a dedicated and effective advocate for investing in biomedical research into major diseases like diabetes and Alzheimer’s, as well as public health programs like pandemic preparedness.

She has also long championed women’s health issues, proving a vocal critic of the Trump administration’s proposed gag rule on Title X funding, among other policies. Watch for her to continue to push back on the administration’s efforts to restrict access to abortion rights.

And on the Senate side, the Committee on Finance: Sen. Chuck Grassley, Iowa?

The rumor mill favors Grassley, the Republican who has served most recently as the chairman of the Senate Committee on the Judiciary, to replace retiring Sen. Orrin Hatch (R-Utah).

Senate Republican leaders have signaled that entitlement programs like Medicare and Medicaid could use trimming and, with Republicans emerging from the midterms with a slightly bigger majority, this committee could have its hands full.

Grassley held the chairmanship from 2003 to 2006, leaving him two more years at the top, should he want it. (Senate Republican chairs may serve for only six years.) But he might choose to stay on as head of the Judiciary Committee, in which case the next chairman may be the next-most-senior Republican: Sen. Mike Crapo of Idaho.

]]>Nancy Pelosi And Congressional Democrats Gather In Washington DC For Election NightkhnemmariehMidterm Results Show Health Is Important To Voters But No Magic Bullethttps://khn.org/news/midterm-results-show-health-is-important-to-voters-but-no-magic-bullet/
Wed, 07 Nov 2018 11:19:43 +0000http://khn.org/?p=888755[UPDATED at 1:50 p.m. ET]

Health care proved important but apparently not pivotal in the 2018 midterm elections on Tuesday as voters gave Democrats control of the U.S. House, left Republicans in charge in the Senate and appeared to order an expansion of Medicaid in at least three states long controlled by Republicans.

In taking over the House, Democrats are unlikely to be able to advance many initiatives when it comes to health policy, given the GOP’s control of the Senate and White House. But they will be able to deliver an effective veto to Republican efforts to repeal the Affordable Care Act, convert the Medicaid health care system for low-income people into a block grant program and make major changes to Medicare.

One likely development is an expansion of Medicaid in several of the 18 states that had so far not offered coverage made available by the Affordable Care Act. Voters in Idaho and Nebraska easily approved ballot measures calling for expansion. A similar measure was leading in Utah based on incomplete returns.

In Montana, voters are deciding if the existing expansion should be continued and the state’s expenses covered by raising tobacco taxes. In preliminary results, opponents outnumbered supporters, but key counties were not expected to release their tallies until Wednesday.

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Medicaid might also be expanded in Kansas, where Democratic gubernatorial candidate Laura Kelly defeated GOP Secretary of State Kris Kobach. The Kansas legislature had previously passed Medicaid expansion, but it was vetoed in 2017 by former GOP Gov. Sam Brownback. Kobach had not supported the ACA expansion.

And in Maine, where voters approved Medicaid expansion in 2017 but GOP Gov. Paul LePage refused to implement it, Democrat Janet Mills was victorious. She has promised to follow the voters’ wishes. LePage was not running.

The abortion issue was also on the ballot in several states. In Alabama and West Virginia, voters approved state constitutional amendments that would make it easier for the states to ban abortion entirely if the Supreme Court were to overturn Roe v. Wade. Oregon voters, on the other hand, defeated a measure that would have restricted public funding of abortion and insurance coverage for abortion.

The mixed results allowed both sides of the polarized abortion debate to claim victory.

“This election is a major victory … for everyone in this country who cares about access to health care and access to reproductive health care,” Deirdre Schifeling, executive director of Planned Parenthood Votes, told reporters in a conference call.

Said Marjorie Dannenfelser, president of the anti-abortion Susan B. Anthony List: “Yesterday was a clear victory for the pro-life movement. The Senate once again has a pro-life majority — a ringing affirmation of President Trump’s pro-life agenda from the American people, who have seen him deliver on a key promise by appointing two outstanding Supreme Court justices.”

In exit polling, as in many earlier surveys in 2018, voters said that health care, particularly preserving protections for people with preexisting conditions, was their top issue. But health care remained more important to Democrats than to Republicans.

Those who urged Democrats to emphasize health care this year took credit for the congressional successes. “The race for the House was a referendum on the Republican war on health care. You know it, I know it, and the Republican incumbents who shamefully tried to cover up their real record on health care and lost their seats know it,” said Brad Woodhouse of the advocacy group Protect Our Care.

But the issue was not enough to save some of the Senate Democrats in states won by President Donald Trump in 2016. Sen. Claire McCaskill (D-Mo.) was defeated by GOP Attorney General Josh Hawley, who is a plaintiff in a key lawsuit seeking to declare the Affordable Care Act unconstitutional. Sens. Heidi Heitkamp (D-N.D.) and Joe Donnelly (D-Ind.), who also campaigned hard on health care, were defeated.

Nonetheless, Sen. Joe Manchin (D-W.Va.) beat Republican Patrick Morrisey, the state’s attorney general who is also a plaintiff in the lawsuit seeking to upend the ACA.

Rep. Nancy Pelosi (D-Calif.), the leader of the House Democrats who would be first in line to take over as speaker, told supporters gathered in Washington for a victory celebration that her caucus would make health care a key legislative issue.

“It’s about stopping the GOP and [Senate Majority Leader] Mitch McConnell’s assault on Medicare, Medicaid and the Affordable Care Act and the health care of 130 million Americans living with preexisting medical conditions,” she said. She pledged that Democrats would take “very, very strong legislative action” to lower the cost of prescription drugs.

In a wide-ranging news conference on Wednesday, Trump struck something of a conciliatory tone toward the new Democratic majority in the House.

“I believe Nancy Pelosi and I can work together to get a lot of things done,” Trump said. “I suspect [House Democrats] will come up with some fantastic ideas that I can support … including prescription drug prices.”

Among the many new faces in the House is at least one with some significant experience in health policy. Former Health and Human Services Secretary Donna Shalala, who ran the department for all eight years of the Clinton administration, won an open seat in Florida.

Several members of the House and Senate were reelected despite serious ethical and legal troubles. Among them was Rep. Chris Collins (R-N.Y.), who was charged in August with violating insider trading laws while promoting Innate Immunotherapeutics, a small Australian biotech company.

]]>(Maria Fabrizio for KHN)khnjulierHello? It’s I, Robot, And Have I Got An Insurance Plan For You!https://khn.org/news/robocalls-health-insurance-plans-open-enrollment/
Tue, 06 Nov 2018 10:05:22 +0000http://kaiserhealthnews.wordpress.com?p=888450&preview=true&preview_id=888450“Anna” will not stop calling. She really, really wants to sell you health insurance.

What a lot of consumers really, really want is to smack Anna upside her robocalling head.

As health insurance open-enrollment season gets underway in California and nationwide, automated phone calls offering Affordable Care Act or other health plans are spiking — and driving many consumers to the brink. California residents may have it worst, because its open-enrollment period is twice as long as in other parts of the country.

“It’s at epidemic levels at this time of year,” said Aaron Foss, founder of Nomorobo, who estimates his spam call-blocking service, based in Long Island, N.Y., headed off more than 850,000 health-related robocalls in October alone — nearly five times their interceptions for September, Foss said.

Nomorobo tracked about 820 different robocall pitches for health insurance in the last week of October. More than 100 of them were from the robot Anna.

Almost all of these calls are illegal, according to rules published by the Federal Trade Commission in 2009. Many offer skimpy health plans that don’t cover what you might need, insurance regulators and consumer advocates say. Others, they say, are downright fraudulent, with unscrupulous insurance “brokers” taking payment and promising insurance that never comes through.

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Alice Cave, 62, a retired data analyst from Alexandria, Va., who spends winters in Tucson, said she’s gotten so many of these calls that she typically won’t answer her phone unless she recognizes the number. On Monday, expecting a call from a California reporter, she answered her cellphone.

It was “Anne.” (Anna’s robot cousin? Other relatives include “Jordan,” “Allison” and “Mandy,” though variants on Anna remain most prevalent.)

“She was saying, ‘I really need to talk to you — we’ve got deals on health insurance.’ I thought, ‘God, what a crock,’” Cave said. “If it’s too good to be true, it probably is. Anything that comes in on the phone, I’m going to be skeptical. Why would they offer me this deal? I already have great insurance. It’s crazy.”

Some fed-up consumers try to stymie robocallers, with amusing results. Twitter user Jon Heise in June confounded his robot by insisting, after whatever it said, that he was a “meat popsicle.” Eventually, it hung up.

Dealing with a scam robocall yesterday

Scammer: I understand you are looking for new insurance

Me: Negative, I am a meat popsicle.

Scammer: I’m sorry I didn’t under stand, I heard you’re looking for insurance

It’s not all fun and games. In California, the Department of Insurance is investigating health insurance robocalls, said Janice Rocco, deputy commissioner for health policy and reform. In late August, the agency filed a court order against Health Plan Intermediaries Holdings LLC, accusing the Florida company of deceptive and misleading practices in selling “Obamacare” plans that didn’t comply with the health law. The company could face fines of up to $10,000 per violation, Rocco said.

In this case, the company’s robocalls featured “Anne,” according to the court order. In its legal response, the company did not admit to the agency’s allegations and denied responsibility. A hearing date has not yet been set, Rocco said. (Arkansas’ insurance commissioner issued a cease and desist order against the company in 2016.)

Under federal law, calls using prerecorded messages are legal only for such things as doctor appointment reminders, flight cancellations, credit card fraud alerts and political candidates. Calls to sell products and services are not.

In a typical robocall sales pitch, a friendly female voice comes on the line. Sometimes the call appears to originate from major insurers like Blue Cross Blue Shield or Aetna or from a local number a caller might suppose is a school or neighbor.

Often, the voice will ask the consumer to dial “1” to enroll or “2” to opt out of future calls. Both options can be a trap, experts say.

“If you pick up, you become a lead that’s sent to health insurance agents or brokers,” Nomorobo’s Foss said. And option 2 doesn’t put you on a do-not-call list; it merely lets the spammers know they’ve hit a working number, he added.

A reporter from Kaiser Health News connected with one of the insurance brokers behind one of these robocalls by pressing the dreaded “1.”

A man identifying himself as “Ray Khan” said he’s a licensed insurance broker and provided a National Insurance Producer Registry number. The reporter was unable to locate Khan in that national registry with that number, which was not assigned to anyone.

Khan asked for the reporter’s Social Security number and other personal information. He said he did not have an office and that enrollment needed to be done over the phone. He referred the caller to a website that does not provide information about plans offered but is a platform for consumers to be contacted by brokers.

“It’s a legitimate company. We work for different insurance carriers,” Khan said. “You have to trust someone if you want to do it.”

Remember: Your robocaller may sound friendly, but she is not your friend.

That’s exactly what you shouldn’t do — trust folks who call you out of the blue, according to the Department of Insurance’s Rocco. “Someone selling a comprehensive medical plan is not going to be reaching you via a robocall,” Rocco said.

Most of what’s sold through these automated calls are so-called skinny plans that don’t comply with Affordable Care Act requirements, or are short-term insurance plans, which typically offer coverage for only a few months and often don’t cover preexisting conditions or prescription drugs. Such plans have been outlawed in California, starting Jan. 1.

Despite state and federal crackdowns — some involving multimillion-dollar fines — robocalls aren’t going away anytime soon. So the best thing for consumers to do when they receive one is to just hang up or, like Virginia resident Cave, not respond to unfamiliar numbers, advises the Federal Communications Commission.

]]>spam-callskhnbarbaraoThe Election’s Impact On Health Care: Some Bellwether Races To Watchhttps://khn.org/news/the-elections-impact-on-health-care-some-bellwether-races-to-watch/
Fri, 02 Nov 2018 09:00:11 +0000http://khn.org/?p=887315Voters this year have told pollsters in no uncertain terms that health care is important to them. In particular, maintaining insurance protections for preexisting conditions is the top issue to many.

But the results of the midterm elections are likely to have a major impact on a broad array of other health issues that touch every single American. And how those issues are addressed will depend in large part on which party controls the U.S. House and Senate, governors’ mansions and state legislatures around the country.

All politics is local, and no single race is likely to determine national or even state action. But some key contests can provide something of a barometer of what’s likely to happen — or not happen — over the next two years.

For example, keep an eye on Kansas. The razor-tight race for governor could determine whether the state expands Medicaid to all people with low incomes, as allowed under the Affordable Care Act. The legislature in that deep red state passed a bill to accept expansion in 2017, but it could not override the veto of then-Gov. Sam Brownback. Of the candidates running for governor in 2018, Democrat Laura Kelly supports expansion, while Republican Kris Kobach does not.

Here are three big health issues that could be dramatically affected by Tuesday’s vote.

1. The Affordable Care Act

Protections for preexisting conditions are only a small part of the ACA. The law also made big changes to Medicare and Medicaid, employer-provided health plans and the generic drug approval process, among other things.

Republicans ran hard on promises to get rid of the law in every election since it passed in 2010. But when the GOP finally got control of the House, the Senate and the White House in 2017, Republicans found they could not reach agreement on how to “repeal and replace” the law.

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This year has Democrats on the attack over the votes Republicans took on various proposals to remake the health law. Probably the most endangered Democrat in the Senate, Heidi Heitkamp of North Dakota, has hammered her Republican opponent, U.S. Rep. Kevin Cramer, over his votes in the House for the unsuccessful repeal-and-replace bills. Cramer said that despite his votes he supports protections for preexisting conditions, but he has not said what he would do or get behind that could have that effect.

Polls suggest Cramer has a healthy lead in that race, but if Heitkamp pulled off a surprise win, health care might well get some of the credit.

And in New Jersey, Rep. Tom MacArthur, the moderate Republican who wrote the language that got the GOP health bill passed in the House in 2017, is in a heated race with Democrat Andy Kim, who has never held elective office. The overriding issue in that race, too, is health care.

It is not just congressional action that has Republicans playing defense on the ACA. In February, 18 GOP attorneys general and two GOP governors filed a lawsuit seeking a judgment that the law is now unconstitutional because Congress in the 2017 tax bill repealed the penalty for not having insurance. Two of those attorneys general — Missouri’s Josh Hawley and West Virginia’s Patrick Morrisey — are running for the Senate. Both states overwhelmingly supported President Donald Trump in 2016.

The attorneys general are running against Democratic incumbents — Claire McCaskill of Missouri and Joe Manchin of West Virginia. And both Republicans are being hotly criticized by their opponents for their participation in the lawsuit.

Although Manchin appears to have taken a lead, the Hawley-McCaskill race is rated a toss-up by political analysts.

But in the end the fate of the ACA depends less on an individual race than on which party winds up in control of Congress.

“If Democrats take the House … then any attempt at repeal-and-replace will be kaput,” said John McDonough, a former Democratic Senate aide who helped write the ACA and now teaches at the Harvard School of Public Health.

Conservative health care strategist Chris Jacobs, who worked for Republicans on Capitol Hill, said a new repeal-and-replace effort might not happen even if Republicans are successful Tuesday.

“Republicans, if they maintain the majority in the House, will have a margin of a half dozen seats — if they are lucky,” he said. That likely would not allow the party to push through another controversial effort to change the law. Currently there are 42 more Republicans than Democrats in the House. Even so, the GOP barely got its health bill passed out of the House in 2017.

And political strategists say that, when the dust clears after voting, the numbers in the Senate may not be much different so change could be hard there too. Republicans, even with a small majority last year, could not pass a repeal bill there.

2. Medicaid expansion

The Supreme Court in 2012 made optional the ACA’s expansion of Medicaid to cover all low-income Americans up to 138 percent of the poverty line ($16,753 for an individual in 2018). Most states have now expanded, particularly since the federal government is paying the vast majority of the cost: 94 percent in 2018, gradually dropping to 90 percent in 2020.

Still, 17 states, all with GOP governors or state legislatures (or both), have yet to expand Medicaid.

McDonough is confident that’s about to change. “I’m wondering if we’re on the cusp of a Medicaid wave,” he said.

Four states — Nebraska, Idaho, Utah and Montana — have Medicaid expansion questions on their ballots. All but Montana have yet to expand the program. Montana’s question would eliminate the 2019 sunset date included in its expansion in 2016. But it will be interesting to watch results because the measure has run into big-pocketed opposition: the tobacco industry. The initiative would increase taxes on cigarettes and other tobacco products to fund the state’s increased Medicaid costs.

In Idaho, the ballot measure is being embraced by a number of Republican leaders. GOP Gov. Butch Otter, who is retiring after three terms, endorsed it Tuesday.

But the issue is in play in other states, too. Several non-expansion states have close or closer-than-expected races for governor where the Democrat has made Medicaid expansion a priority.

In Florida, one of the largest states not to have expanded Medicaid, the Republican candidate for governor, former U.S. Rep. Ron DeSantis, opposes expansion. His Democratic opponent, Tallahassee Mayor Andrew Gillum, supports it.

However, the legislatures in both states have opposed the expansion, and it’s not clear if they would be swayed by arguments from a new governor.

3. Medicare

Until recently, Republicans have remained relatively quiet about efforts to change the popular Medicare program for seniors and people with disabilities.

Their new talking point is that proposals to expand the program — such as the often touted “Medicare-for-all,” which an increasing number of Democrats are embracing — could threaten the existing program.

“Medicare is at significant risk of being cut if Democrats take over the House,” Rep. Greg Gianforte (R-Mont.) told the Lee Montana Newspapers. “Medicare-for-all is Medicare for none. It will gut Medicare, end the VA as we know it, and force Montana seniors to the back of the line.”

Gianforte’s Democratic opponent, Kathleen Williams, is proposing another idea popular with Democrats: allowing people age 55 and over to “buy into” Medicare coverage. That race, too, is very tight.

Meanwhile, back in Washington, congressional Republicans are more concerned with how Medicare and other large government social programs are threatening the budget.

“Sooner or later we are going to run out of other people’s money,” said Chris Jacobs.

Senate Majority Leader Mitch McConnell suggested in an Oct. 16 interview with Bloomberg News that entitlement programs like Medicare are “the real driver of the debt by any objective standard,” but that bipartisan cooperation will be needed to address that problem

Nov. 1 marks the start of Open Enrollment for people buying their own coverage for 2019 in most states. Despite the turmoil surrounding the Affordable Care Act, most consumers will have more choices and mostly flat — and in some cases lower — premiums.

What will happen to the health law going forward, however, will depend largely on what happens in the midterm elections Tuesday. Important health decisions will result not just from which party controls the U.S. House and Senate, but who wins governorships and comes to control state legislatures as well.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

With changes in the ACA marketplace for 2019, it will be very important for consumers to look at the variety of options. Those earning less than 200 percent of the federal poverty level (just under $24,300 for an individual) are likely well served by silver plans on the federal health law’s exchanges. But the choices for benefits and prices are much more complicated for people earning more than that.

People who don’t get insurance through work or the government and earn too much to qualify for premium subsidies under the health law might be tempted to try the new, less-expensive short-term plans being touted by the Trump administration. But they should be cautious and consider two major downsides: The plans likely won’t cover preexisting conditions, and the benefits will be skimpier than those of ACA plans. For example, many short-term plans are expected not to cover mental health and maternity services or prescription drugs.

Federal officials announced Wednesday that Wisconsin could implement work requirements for some Medicaid enrollees. They also said, however, that the state could not begin drug testing for the enrollees.

If Democrats take control of the House or Senate, it’s possible that they could work with President Donald Trump on some specific issues, especially efforts to bring down drug prices or consumer protections against surprise medical bills.

Perhaps the biggest change that could come from the election results is an increase in the number of states that expand Medicaid under a provision of the ACA. Seventeen states have not taken that step, but several deep-red states in the West have the question on their ballots, and the outcomes from governors’ races in other states could also lead to expansion.

Rovner also interviews Barbara Feder Ostrov, who wrote the latest “Bill of the Month” feature for Kaiser Health News and NPR. It’s about a California college professor whose skin rash led to a $48,000 bill for allergy skin testing. You can read the story here.

If you have a medical bill you would like NPR and KHN to investigate, you can submit it here.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too: